Change in urethral pressure during voluntary pelvic floor muscle contraction and vaginal electrical stimulation

The purpose of the study was to compare the effect of voluntary pelvic floor muscle (PFM) contraction and vaginal electrical stimulation on urethral pressure. Twelve women with genuine stress incontinence, mean age 49.4 years (range 33–66) participated in the study. The urethral and bladder pressures were recorded simultaneously through a double-lumen 8 Ch catheter. The patients first performed three voluntary PFM contractions. Then two electrical stimulators, Conmax and Medicon MS 105, 50 Hz, were used in random order. A visual analog scale was used to measure pain and discomfort. Pain was reported to mean 6.8, SEM 0.64 (range 0.7–9.9) and mean 6.1, SEM 0.81 (range 0–9.1) with Conmax and Medicon MS 105, respectively. The mean paired difference in favor of voluntary contraction with Conmax was ?8.0, SD 6.7,P=0.0067, and with Medicon MS 105 it was ?12.2, SD 5.9,P=0.0022. The results demonstrated that voluntary PFM contraction increased urethral pressure significantly more than did vaginal electrical stimulation.     

Assessment of postoperative pain: impact of clinical experience and professional role

Background: Unrelieved postoperative pain is still reported to be a rather common clinical problem which may be related to inadequate routines for pain assessment. Therefore, the aim of the study was to describe strategies used by experienced and less experienced nurses and physicians in their assessment of postoperative pain and to relate different approaches, clinical experience, and professional role to the accuracy of the pain ratings.
Methods: Data collection was based on repeated interviews with nurses (n=30) and physicians (n=30) in connection with clinical pain assessments (n=180) including VASscoring
Results: Commonly used strategies in the pain assessment were: - how the patient looks, - what the patient says, - the manner of talking, and - past experience of similar circumstances. The mean VAS-score given by the patients (6.1±21.1) was significantly (P<0.001) higher than that rated by the staff members (4.9±21.2). Nurses as well as physicians overestimated low and underestimated high levels of pain indicated by the patients. The accuracy of the ratings by nurses, especially by more experienced ones (≤10 years in nursing), was found to be less precise than that of physicians. The pain assessment of these very experienced nurses was characterized by a systematic underestimation.
Conclusions: The present study emphasizes a need for definition of more precise strategies for clinical postoperative pain assessment which better take into consideration the pain experiences and needs of individual patients     

High-quality recording of bioelectric events

A multichannel instrumentation amplifier, developed to be used in a miniature universal eight-channel amplifier module, is described. After discussing the specific properties of a bioelectric recording, the difficulties of meeting the demanded specifications with a design based on operational amplifiers are reviewed. Because it proved impossible to achieve the demanded combination of low noise and low power consumption using commercially available operational amplifiers, an amplifier equipped with an input stage with discrete transistors was developed. A new design concept was used to expand the design to a multichannel version with an equivalent input noise voltage of 0·35 μV RMS in a bandwidth of 0·1–100 Hz and a power consumption of 0·6 mW per channel. The results of this study are applied to miniature, universal, eight-channel amplifier modules, manufactured with thick-film production techniques. The modules can be coupled to satisfy the demand for a multiple of eight channels. The low power consumption enables the modules to be used in all kinds of portable and telemetry measurement systems and simplifies the power supply in stationary measurement systems.     

Effects of Clodronate on Cortical and Trabecular Bone in Ovariectomized Rats on a Low Calcium Diet

The aim of this study was to evaluate the contribution of a low calcium diet to the cortical and trabecular osteoporosis seen in ovariectomized rats after 7 weeks on a low calcium diet and to investigate the effects of the bisphosphonate clodronate on this development of osteoporosis. Thirty-six mature, female Wistar rats were randomized into four groups: Ovx−B (bisphosphonate) and Ovx−C (control) were ovariectomized, and Sham−Ca (low calcium) and Sham+Ca (normal calcium) were sham operated. The first three groups were fed a low calcium diet (0.01%) and Sham+Ca normal rat chow (Ca 1.1%). The Ovx−B received 10 mg/kg s.c. clodronate daily for nine weeks, and Ovx−C, Sham−Ca, and Sham+Ca received the same volumes of saline. Bone mineral turnover measured as ⁸⁵Sr-uptake was increased in all low calcium groups compared to Sham+Ca. The Sham+Ca femora had higher dry weight and ash weight than the other groups, and Ovx−C had higher dry weight compared with Ovx−B and Sham−Ca. Calcium content was lower in both Ovx groups compared to both Sham groups. Magnesium was lower in all groups compared to Sham+Ca and higher in Ovx−B compared with Ovx−C. In the femoral shaft, Sham+Ca had significantly higher ultimate bending moment, energy absorption, and deflection compared to the other three groups. Ultimate bending moment was higher in Sham−Ca than in Ovx−C. Stiffness was increased in both Sham+Ca and Ovx−B compared to Ovx−C. The maximum stress in the femoral midshaft was higher in Sham+Ca than in the other groups, and higher in Ovx−B than in Ovx−C. Histomorphometry showed increased medullary area in all low calcium groups compared to Sham+Ca and larger cortical area in Sham+Ca and Ovx−B compared to Ovx−C. Compared to Sham+Ca the trabecular bone volume was decreased to 30% in Sham−Ca and to 9% in Ovx−C, but was unchanged in Ovx−B. The low calcium diet generally increased bone mineral turnover and reduced the tibial bone volume. Femoral changes led to a reduction of cortical fracture strength and maximal stress. Ovariectomy in addition to a low calcium diet reduced femoral strength even more. Daily injections of clodronate to ovariectomized rats on a low calcium diet increased femoral shaft stiffness and maximum stress, and clodronate preserved both trabecular and cortical tibial bone volume completely. Received: 11 June 1996 / Accepted: 5 March 1997     

An audit of the safety of an acute pain service

We audited and analysed the adverse effects and safety of postoperative pain management on 2509 consecutive patients under care of the Acute Pain Service at a tertiary referral teaching hospital over a 32-month period. Our standard respiratory monitoring consisted of continuous pulse oximetry, hourly respiratory rate counting, sedation scoring and intermittent arterial blood gas sampling. This protocol was reliable and detected six episodes of bradypnoea, 13 of hypercapnia and 23 of oxygen desaturation occurring in 39 patients (1.8% of all spontaneously breathing patients) . Two patients required naloxone injection and none had long-term sequelae. Hypotension due to epidural bupivacaine 0.0625% and fentanyl 3.3 μg.ml⁻¹ infusion occurred in four patients (1.2%), all with a sensory block higher than T₅. They readily responded to fluid infusion and ephedrine (two patients). Postoperative nausea or vomiting occurred in 723 (28.8%) and 380 (15.1%) patients, respectively. Odds ratio analysis showed that the risk factors for postoperative nausea and vomiting were: female gender, gynaecological operations, nongeriatric patients and systemic analgesia. Postoperative nausea and vomiting decreased analgesic efficacy by discouraging the use of patient-controlled analgesia and was regarded as equally distressing as pain. Other side-effects included: pruritus in 182 patients; dizziness in 333 and lower limb weakness in 73 (21.2% of patients receiving epidural local anaesthetics). It is concluded that a standard monitoring and management protocol, an experienced nursing team and reliable Acute Pain Service coverage is mandatory for the safe use of modern analgesic techniques.     

Thermoreceptive lamina I trigeminothalamic neurons project to the nucleus submedius in the cat

Summary The technique of antidromic mapping with a roving array of electrodes was used to demonstrate that lamina I trigeminothalamic cells responsive specifically to skin temperature project to the n. submedius (Sm) in the medial thalamus of the cat. This finding indicates that Sm receives thermoreceptive in addition to nociceptive information.     

Loading anticancer drugs into HDL as well as LDL has little affect on properties of complexes and enhances cytotoxicity to human carcinoma cells

Low density lipoprotein (LDL) has been found to represent a suitable carrier for cytotoxic drugs that may target them to cancer. This study investigated whether very low density lipoprotein (VLDL), LDL and high density lipoprotein (HDL) can be used to effectively incorporate four cytotoxic drugs, 5-fluorouracil (5-FU), 5-iododeoxyuridine (IUdR), doxorubicin (Dox) and vindesine; characterized the complexes; and examined the effect of incorporation on drug cytotoxicity against HeLa cervical and MCF-7 breast carcinoma cells. Significant drug loading was achieved into all three classes of lipoproteins, consistent with the sizes and hydrophobicity of the drugs. The relative loading efficiency was found to be vindesine>IUdR>Dox>5-FU for all three classes of lipoproteins. As shown by electron microscopy (EM), drug incorporation did not affect the size or morphology of the lipoproteins. Differential scanning calorimetry (DSC) showed that drug loading did not significantly change the thermal transition temperature of core lipids in the lipoproteins. The transition enthalpy was changed only for LDL–Dox and LDL–vindesine. The drugs remained stable in the lipoproteins as determined by high performance liquid chromatography (HPLC). EM, DSC and HPLC data suggest that drugs were incorporated into lipoproteins without disrupting their integrity and drugs remained in their stable forms inside lipoproteins. Compared with free drugs in cytotoxicity assays, the IC₅₀ values of LDL– and HDL–drug complexes were significantly lower (2.4- to 8.6-fold for LDL complexes and 2.5- to 23-fold for HDL complexes). All free or lipoprotein-bound drug formulations were comparably more cytotoxic against MCF-7 than HeLa cells. Upregulating the lipoprotein receptors enhanced, and downregulating them inhibited, the cytotoxicity, indicating the mechanistic involvement of lipoprotein receptor pathways. Complexes of all four drugs with VLDL, in contrast to LDL and HDL, had the same cytotoxicity as the four corresponding free drugs. Our results suggest that further studies are required of the potential of HDL to be a cancer targeting drug carrier.     

低分子肝素对不稳定型心绞痛病理生理干预作用的研究

目的:观察低分子肝素(LMWH)对不稳定型心绞痛((UAP)的临床症状、心电图、血脂以及内皮素(ET)的影响。方法:前瞻性地将84例UAP患者随机分为两组:对照组使用硝酸甘油、倍他乐克、阿司匹林等药物;治疗组(LMWH组)在上述治疗基础上加用LMWH(速避凝)。治疗前后调查临床症状以及心电图改变,抽血测定血脂、红细胞压积、血小板及内皮素水平的变化。结果:两组治疗后,患者心绞痛发作次数、持续时间以及硝酸甘油的用量明显减少,心电图明显改善,且LMWH组优于对照组(P<0.05)。LMWH治疗后,患者HCT、TC、TG及ET较治疗前明显降低(P<0.05)。对照组血浆ET水平无变化。结论:LMWH对UAP患者不仅具有抗凝抗栓作用,而且可以降低血液粘度、保护血管内皮细胞,纠正脂类代谢紊乱状态,     

Analgesic actions of dynorphin A(1–13) antiserum in the rat brain stem

This study was performed to evaluate the effects of dynorphin A(1–13) antiserum when microinjected into an active hyperalgesic region within the rat brain stem. When administered within the dorsal posterior mesencephalic tegmentum (DPMT) of intact conscious rats, dynorphin A(1–13) antiserum produced rapid onset and persistent prolongation of a low intensity thermally evoked tail avoidance response (LITETAR). These analgesic actions of the dynorphin A(1–13) antiserum appeared to be dose dependent. These studies support previous hypotheses about the existence of tonically active brain stem opioid hyperalgesic processes. Further, the results provide indirect evidence for a potential role of brain stem dynorphin(s) in facilitating pain.     

Clinical and manometric evaluation of anorectal function following low anterior resection with low anastomotic line using an EEA™ stapler for rectal cancer

Anorectal function was evaluated in eight patients who had low anterior resection of the rectum with a low anastomotic line, using an EEA^™ stapler, with determination of function based on periodic manometric studies and clinical symptoms. Immediately following surgery all patients suffered from frequent bowel actions and soiling. These symptoms improved with time and most patients could enjoy almost normal daily life by the sixth postoperative month. One month after surgery, anal canal resting pressure and maximum squeeze pressure were significantly reduced and rectoanal inhibitory reflex was absent; neither showed a distinct tendency to improve thereafter. Rectal sensation and reservoir capacity, which also were seriously impaired, recovered satisfactorily by the time of the six-month examination. This suggests that an improvement of clinical symptoms following this operation is dependent upon the recovery of reservoir capacity and sensation of the neorectum, and that this operative procedure is a functionally acceptable option for low rectal cancer.